What is Postural Orthostatic Tachycardia Syndrome (POTS)?
Postural orthostatic tachycardia syndrome (POTS) is a condition that makes a person feel faint or dizzy. This happens when the autonomic nervous system, which controls things like heart rate and blood pressure, doesn’t work properly.
Normally, the autonomic nervous system makes sure that the brain gets enough blood flow whether a person is standing, lying down, or sitting. When someone stands up, this system causes blood vessels in the lower body to tighten, preventing blood from pooling in the legs and making sure enough blood reaches the brain. In people with POTS, this system doesn’t work correctly. The blood vessels can’t maintain proper blood flow to the brain, so the heart beats faster to try to compensate. This causes symptoms like dizziness, lightheadedness, and fainting. POTS can affect both kids and adults, with symptoms ranging from mild to severe.
What are Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS)?
In kids and teens, POTS causes a heart rate increase of 40 or more beats per minute as they transition from a lying down position to a standing one. This causes the nervous system to breakdown and causes the major symptoms of POTS, including:
- Heart palpitations
- Instability (feeling like one is about to fall)
- Lightheadedness (almost passing out; vision tunnels or goes gray or dark)
- Dizziness
- Passing out (fainting)
- Fatigue
- Chest pain
- Trouble breathing
- Cold or painful extremities (hands, feet)
- Nausea
- Problems exercising
- Redness or purple coloring in the lower legs
- Shaking
Many POTS symptoms happen only when a patient is standing or changing to a standing position. However, other symptoms can occur even while seated or at rest, including:
- Headaches
- Sweating without a cause (such as exercise or warm weather)
- Troubles concentrating
- Troubles sleeping or unable to sleep (insomnia)
- General weakness
How is POTS Diagnosed?
While there is no one true test to diagnose the condition, pediatric specialists at Rady Children’s will start by completing a physical exam and reviewing your child’s medical history. In many cases, further testing will help them to confirm or rule out a diagnosis of POTS. POTS is often assessed through a Tilt Table Test. In this test, a patient is strapped to a table and then tilted from lying on the back position into a standing one. During this process, heart rate and blood pressure are monitored. If the heart rate increases dramatically without a related increase in blood pressure, then POTS could be the cause. Beyond direct testing, doctors at Rady Children’s will work to assess whether a factor outside the autonomic nervous system could be causing these problems. They may check your child’s blood, heart, brain, eyes, ears, kidneys, muscles, nerves, hormones, digestive tract, and more. Typically, a diagnosis of POTS is confirmed when symptoms have lasted for several months and no other causes are found.
POTS is a chronic, long-term condition. However, many kids with POTS find that their symptoms get better as they grow older, often disappearing completely by their early 20s.
While there is no cure, doctors will often try to treat the underlying causes behind this condition. This includes both direct treatments and lifestyle changes, including:
- More water and salt intake
- Better and longer sleep
- A slow increase in exercise, starting with seated, reclined, or horizontal exercises (rowing, recumbent bicycling, and swimming)
- Wearing compression (squeezing) stockings
- Raising the head of the bed so some pressure stays in the blood vessels in the legs during sleep
- Psychological counseling to help manage stress and choices that trigger symptoms
- Prescription medicines
How Does Rady Children’s Help Manage and Support Patients with POTS?
Treatment options are available to those who need it. At Rady Children’s, we work with patients like Ellie Barnes to help them return to full function. Our Inpatient Chronic Pain Management Program is available to patients requiring intensive help, including highly focused care plans emphasizing physical and mental health. Alongside rehabilitation and exercise, patients and their families are given counseling to better understand how the condition affects the body and coping mechanisms to fight negative thoughts.
At Rady Children’s, a major point of emphasis is the role of the family in helping children recover from a long-term, debilitating illness. Our pediatric specialists and support team will provide your family with the resources you need to maintain a positive outlook and encourage mental well-being for your child with POTS. This includes support groups, online forums, and educational resources to help manage the day-to-day reality of living with POTS and plan for the future ahead.
While a diagnosis of POTS can be frustrating and scary, it is a manageable condition that patients often outgrow. If you feel like your child has balance issues or other associated symptoms, don’t hesitate to reach out to a pediatric specialist for a consultation. They will help to diagnose your child, treat any symptoms, and work to return your child to full function and a happy, healthy life.
Sources:
https://www.rchsd.org/health-article/postural-orthostatic-tachycardia-syndrome-pots/